How Much Help Is Too Much?

I've been using the Nintendo Wii with more of my patients. This has created a dilemma for me. I don't know how much help to give my patients. At first I didn't help them at all but that wasn't successful. Since then I have alternated between verbal cues for strategy, tactile cues to follow the strategy and manually assisting them with playing the game, all with the intent of facilitating motor learning. The problem is my patients are more concerned with winning the game.

I like the system because it provides visual feedback for weight shifting and balance. The game scores give me an objective measure of improvement. But it is only objective if I don't help. I can't quantify how much physical help I give patients. The usual minimal, moderate and maximal assist don't really translate to the situation. I don't think verbal cues for strategy are a problem.

My biggest challenges are those patients having trouble moving in one direction. Ideally I want to step back and let them figure it out themselves. At first I would assist them with the movements to teach them what it felt like, then cue them as necessary. That works until the frustration at not being able to score sets in. Then I have to help. Sometimes I have to physically move them in the proper direction and control the force they exert. Yes, they were able to advance and get a higher score but I had no way to measure motor learning.

Practice doesn't translate into perfect. If anything it causes the opposite, because there is no opportunity for error correction or novel movements. Somewhere in there is a fine line between helping too much and not helping enough. My saving grace is that we play the games over and over again, so we get lots practice. As we play, I decrease my assist. Sometimes I don't help at all and the score shows it. Sometimes I help a lot to boost the score.

Overall I'm havig success. Two of my ladies are able to play the advanced versions of three games with SBA for balance. Their scores vary but are usually on the high end. If we keep going at this rate I'm going to have to start playing Wii at lunch again to learn some more strategy. I consider this research. Maybe not -- I might make them learn it as we go along. They might think it's more fun.